It is known in the art relating to jugular and subclavian access site dressings used during and shortly after medical procedures such as open heart or thoracic surgery that the dressings have a tendency to become dislodged from the patient's skin, thereby exposing the access site to harmful bacteria and other pathogens. Some common forms of traditional access site dressings include self-adherent protective bandage tape or clear film product alternatives that use non-sensitizing hypoallergenic adhesives to cover all or part of the indwelling catheter access site. Some dressings also combine non-woven tape and absorbent gauze-like materials which have skin-mating surfaces of non-adherent film to reduce the effect of adhesive stripping caused by the dressing removal. One known dressing system includes an opaque pad for adhesive placement over an access site and an adhesive strip, for adhesive securement to the skin of a patient under a catheter tube as it emerges from underneath the pad, and between the skin and the pad along the edges of the pad in opposite directions from the tube exit location. A known transparent type dressing includes a transparent film that does not adhere to the wound site to be viewed. This transparent dressing allows for the placement of a gauze or other absorbent material beneath the transparent film layer over the wound in order to provide absorbency thereby defeating the ability to view the wound site.
Further, in known prior art access site dressings, the side arm of an introducer sheath, which is at a 60 or 90 degree angle to the introducer sheath secured by the dressing, and other medical tubing and connectors, and stresses imparted thereto, can cause separation of the dressing from a patient's skin. When a patient moves his or her head, the side arm acts as a lever and tears loose the dressing. This is undesirable because a patient will often move his or her head and the dressing is ineffective if it releases from the patient's skin. Also, the side arm tends not to stay flat against a patient's body but instead projects or lifts up off the body, which further loosens the dressing. Even more, other medical tubing located at the access site, such as central venous catheters (CVC's), often dangle insecurely from the jugular access site. When this tubing gets caught on other objects, such as medical instruments or medical personnel's clothing, the force of the tubing catching also can tear the dressing from the access site.
Further, known prior art access site dressings have not been able to accommodate all of the potential combinations of medical tubing that can exist at a jugular access site. For example, during open heart and/or thoracic surgery, a jugular access site may accommodate an introducer sheath alone or an introducer sheath along with either a single, double, or triple lumen central venous catheters (CVC's). Alternatively, there may be an introducer sheath in combination with a pulmonary artery catheter (PAC) (for example a Swan-Ganz or similar) or an introducer sheath in combination with a Swan-Ganz catheter along with either a single, double, or triple lumen CVC's. Finally, after surgery in the operating room, the introducer sheath is usually removed within one to two days, but the CVC (either single, double, or triple lumen) may remain in the access site for up to seven or more days. The prior art dressings have been able to accommodate some of these combinations but no prior art dressing has been suitable for use with all of these possible combinations. Even those which do accommodate a few combinations often come loose from the skin within a day or less, and thus serve no useful clinical purpose.
Moreover, for medical procedures involving the jugular or subclavian access site, either a right side or a left side access site may be used. It is preferable to use the right side access site, but in approximately 40% of the cases, it is necessary to use the left side access site. Prior art access site dressings are capable of being used on either the right hand side or the left hand side, however, they do not secure and protect the catheters and access sites, and come loose prematurely on either the left or right side.
Furthermore, prior jugular and subclavian access site systems have not been able to suitably anchor the medical tubing that leads up to the access site. As previously mentioned, this is problematic for the reason that this tubing tends to dangle from the patient and can be pulled if caught on other objects or people. This not only puts a tearing pressure on the jugular access site dressing, but also can pull the medical tubing away from the access point on the patient's skin. Another shortcoming of prior anchoring methods used in jugular access site systems is that the tubing anchors are not designed in a way to clear the gown of the patient worn by the patient during and after the operating procedure. Most of these anchor devices have a low vertical profile (i.e., vertical height). This results in the tubing being anchored close to the patient's body. When a patient is wearing a hospital gown, the gown interferes with the tubing and/or the anchoring device used to anchor the tubing located at the jugular access site. Finally, prior medical tubing anchors are not able to anchor more than one tube at a time. Surgical procedures such as open heart surgery require multiple medical tubes at the jugular access site. Hence, multiple prior art anchors must be used to secure the medical tubing leading up to the jugular access site.